NPIMap

Individual provider Active NPI

Ryan Fillmore, M.D.

  • Neurocritical Care Physician
  • Charlotte, NC
National Provider Identifier
1184043283
Registry record updated Feb 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurocritical Care PhysicianTaxonomy code 2084A2900X
License
2021-01709 Issued in NC
Practice address
200 Hawthorne LN
Charlotte, NC 28204-2515
Phone
(704) 384-9437
Fax
(704) 384-9440
NPI assigned
Apr 16, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neurocritical Care Physician 2084A2900X 155465 CA
Neurology Physician 2084N0400X 2021-01709 NC
Clinical Neurophysiology Physician 2084N0600X 2021-01709 NC
Neurocritical Care Physician 2084A2900X 2021-01709 NC Primary

Addresses

Primary practice location

200 Hawthorne LN
Charlotte, NC 28204-2515

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-9437

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rfillmore891687@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180622001314 CA Practitioner - Neurology 2567684863 Reassigns benefits to 2 organizations
I20210723000640 NC Practitioner - NeurologyPractitioner - Internal Medicine 2567684863 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

Anaheim, CA 92805
Phone (562) 526-4278

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-5416

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone (336) 718-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
155465CAMDNeurocritical Care Physician
2021-01709NCMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Claifornia Univ Neursciences Neurology CurrentSince Jul 1, 2018 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Jul 4, 2023 Accepting new patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients
Novant Health Medical Group, LLC Clinical Neurophysiology Current Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Neuroelite Services LLC Clinical Neurophysiology CurrentSince Jan 6, 2025 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Novant Medical Group, Inc. CurrentSince Jul 4, 2023 Accepting new patients

Locations

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

200 S Manchester Ave
Ste 300
Orange, CA 92868
Phone (714) 424-9001

1918 Randolph Rd
Ste 400
Charlotte, NC 28207
Phone (704) 384-9437

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

190 Kimel Park Dr
Ste 120
Winston Salem, NC 27103
Phone (336) 277-2200

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

175 Kimel Park Dr
Winston Salem, NC 27103
Phone (336) 718-1006

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: rfillmore891687@direct.novanthealth.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676332800000",
    "number": "1184043283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-9437",
            "fax_number": "704-384-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWTHORNE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042515",
            "telephone_number": "704-384-9437",
            "fax_number": "704-384-9440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FILLMORE",
        "first_name": "RYAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-16",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084A2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurocritical Care",
            "state": "CA",
            "license": "155465",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NC",
            "license": "2021-01709",
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "NC",
            "license": "2021-01709",
            "primary": false
        },
        {
            "code": "2084A2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurocritical Care",
            "state": "NC",
            "license": "2021-01709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rfillmore891687@direct.novanthealth.org",
            "affiliation": "N",
            "endpointDescription": "rfillmore891687@direct.novanthealth.org",
            "address_1": "200 Hawthorne Ln",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282042515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.